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You are viewing information for Noble County, OH

Obamacare 2023 Rates for Noble County

Obamacare > Rates > Ohio > Noble County

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Noble County, OH.

The health insurance rates listed below are for calendar year 2023.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 43 Plans and 2023 Rates for Noble County, Ohio

Below, you’ll find a summary of the 43 plans for Noble County, Ohio and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Anthem Blue Cross and Blue Shield

Local: 1-855-748-1808 | Toll Free: 1-855-748-1808

Toc - Plan #1 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$401.52
$455.73
$513.14
$717.11
$1,089.73 		$708.68
$762.89
$820.30
$1,024.27 		$1,015.84
$1,070.05
$1,127.46
$1,331.43 		$1,323.00
$1,377.21
$1,434.62
$1,638.59 		$307.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$803.04
$911.46
$1,026.28
$1,434.22
$2,179.46 		$1,110.20
$1,218.62
$1,333.44
$1,741.38 		$1,417.36
$1,525.78
$1,640.60
$2,048.54 		$1,724.52
$1,832.94
$1,947.76
$2,355.70 		$307.16
Toc - Plan #2 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X HMO 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$379.24
$430.44
$484.67
$677.32
$1,029.26 		$669.36
$720.56
$774.79
$967.44 		$959.48
$1,010.68
$1,064.91
$1,257.56 		$1,249.60
$1,300.80
$1,355.03
$1,547.68 		$290.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$758.48
$860.88
$969.34
$1,354.64
$2,058.52 		$1,048.60
$1,151.00
$1,259.46
$1,644.76 		$1,338.72
$1,441.12
$1,549.58
$1,934.88 		$1,628.84
$1,731.24
$1,839.70
$2,225.00 		$290.12
Toc - Plan #3 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$505.88
$574.17
$646.51
$903.50
$1,372.96 		$892.88
$961.17
$1,033.51
$1,290.50 		$1,279.88
$1,348.17
$1,420.51
$1,677.50 		$1,666.88
$1,735.17
$1,807.51
$2,064.50 		$387.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,011.76
$1,148.34
$1,293.02
$1,807.00
$2,745.92 		$1,398.76
$1,535.34
$1,680.02
$2,194.00 		$1,785.76
$1,922.34
$2,067.02
$2,581.00 		$2,172.76
$2,309.34
$2,454.02
$2,968.00 		$387.00
Toc - Plan #4 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 7450/0% for HSA (+ Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$407.35
$462.34
$520.59
$727.53
$1,105.55 		$718.97
$773.96
$832.21
$1,039.15 		$1,030.59
$1,085.58
$1,143.83
$1,350.77 		$1,342.21
$1,397.20
$1,455.45
$1,662.39 		$311.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$814.70
$924.68
$1,041.18
$1,455.06
$2,211.10 		$1,126.32
$1,236.30
$1,352.80
$1,766.68 		$1,437.94
$1,547.92
$1,664.42
$2,078.30 		$1,749.56
$1,859.54
$1,976.04
$2,389.92 		$311.62
Toc - Plan #5 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 3200/10% for HSA (+ Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$3,200 $6,400 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$509.06
$577.78
$650.58
$909.18
$1,381.59 		$898.49
$967.21
$1,040.01
$1,298.61 		$1,287.92
$1,356.64
$1,429.44
$1,688.04 		$1,677.35
$1,746.07
$1,818.87
$2,077.47 		$389.43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,018.12
$1,155.56
$1,301.16
$1,818.36
$2,763.18 		$1,407.55
$1,544.99
$1,690.59
$2,207.79 		$1,796.98
$1,934.42
$2,080.02
$2,597.22 		$2,186.41
$2,323.85
$2,469.45
$2,986.65 		$389.43
Toc - Plan #6 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000/20% for HSA (+ Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$412.68
$468.39
$527.41
$737.05
$1,120.01 		$728.38
$784.09
$843.11
$1,052.75 		$1,044.08
$1,099.79
$1,158.81
$1,368.45 		$1,359.78
$1,415.49
$1,474.51
$1,684.15 		$315.70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$825.36
$936.78
$1,054.82
$1,474.10
$2,240.02 		$1,141.06
$1,252.48
$1,370.52
$1,789.80 		$1,456.76
$1,568.18
$1,686.22
$2,105.50 		$1,772.46
$1,883.88
$2,001.92
$2,421.20 		$315.70
Toc - Plan #7 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 5400/0% for HSA ( + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$517.94
$587.86
$661.93
$925.04
$1,405.69 		$914.16
$984.08
$1,058.15
$1,321.26 		$1,310.38
$1,380.30
$1,454.37
$1,717.48 		$1,706.60
$1,776.52
$1,850.59
$2,113.70 		$396.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,035.88
$1,175.72
$1,323.86
$1,850.08
$2,811.38 		$1,432.10
$1,571.94
$1,720.08
$2,246.30 		$1,828.32
$1,968.16
$2,116.30
$2,642.52 		$2,224.54
$2,364.38
$2,512.52
$3,038.74 		$396.22
Toc - Plan #8 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 3000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$518.21
$588.17
$662.27
$925.52
$1,406.42 		$914.64
$984.60
$1,058.70
$1,321.95 		$1,311.07
$1,381.03
$1,455.13
$1,718.38 		$1,707.50
$1,777.46
$1,851.56
$2,114.81 		$396.43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,036.42
$1,176.34
$1,324.54
$1,851.04
$2,812.84 		$1,432.85
$1,572.77
$1,720.97
$2,247.47 		$1,829.28
$1,969.20
$2,117.40
$2,643.90 		$2,225.71
$2,365.63
$2,513.83
$3,040.33 		$396.43
Toc - Plan #9 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$7,950 $15,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$499.02
$566.39
$637.75
$891.25
$1,354.34 		$880.77
$948.14
$1,019.50
$1,273.00 		$1,262.52
$1,329.89
$1,401.25
$1,654.75 		$1,644.27
$1,711.64
$1,783.00
$2,036.50 		$381.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$998.04
$1,132.78
$1,275.50
$1,782.50
$2,708.68 		$1,379.79
$1,514.53
$1,657.25
$2,164.25 		$1,761.54
$1,896.28
$2,039.00
$2,546.00 		$2,143.29
$2,278.03
$2,420.75
$2,927.75 		$381.75
Toc - Plan #10 Anthem Blue Cross and Blue Shield
Catastrophic

(HMO) Anthem Catastrophic Pathway X HMO 9100 ( + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$300.12
$340.64
$383.55
$536.01
$814.53 		$529.71
$570.23
$613.14
$765.60 		$759.30
$799.82
$842.73
$995.19 		$988.89
$1,029.41
$1,072.32
$1,224.78 		$229.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$600.24
$681.28
$767.10
$1,072.02
$1,629.06 		$829.83
$910.87
$996.69
$1,301.61 		$1,059.42
$1,140.46
$1,226.28
$1,531.20 		$1,289.01
$1,370.05
$1,455.87
$1,760.79 		$229.59
Toc - Plan #11 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 6000/25% ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,800 $15,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$502.25
$570.05
$641.88
$897.02
$1,363.11 		$886.47
$954.27
$1,026.10
$1,281.24 		$1,270.69
$1,338.49
$1,410.32
$1,665.46 		$1,654.91
$1,722.71
$1,794.54
$2,049.68 		$384.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,004.50
$1,140.10
$1,283.76
$1,794.04
$2,726.22 		$1,388.72
$1,524.32
$1,667.98
$2,178.26 		$1,772.94
$1,908.54
$2,052.20
$2,562.48 		$2,157.16
$2,292.76
$2,436.42
$2,946.70 		$384.22
Toc - Plan #12 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$406.95
$461.89
$520.08
$726.81
$1,104.46 		$718.27
$773.21
$831.40
$1,038.13 		$1,029.59
$1,084.53
$1,142.72
$1,349.45 		$1,340.91
$1,395.85
$1,454.04
$1,660.77 		$311.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$813.90
$923.78
$1,040.16
$1,453.62
$2,208.92 		$1,125.22
$1,235.10
$1,351.48
$1,764.94 		$1,436.54
$1,546.42
$1,662.80
$2,076.26 		$1,747.86
$1,857.74
$1,974.12
$2,387.58 		$311.32
Toc - Plan #13 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$386.68
$438.88
$494.18
$690.61
$1,049.45 		$682.49
$734.69
$789.99
$986.42 		$978.30
$1,030.50
$1,085.80
$1,282.23 		$1,274.11
$1,326.31
$1,381.61
$1,578.04 		$295.81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$773.36
$877.76
$988.36
$1,381.22
$2,098.90 		$1,069.17
$1,173.57
$1,284.17
$1,677.03 		$1,364.98
$1,469.38
$1,579.98
$1,972.84 		$1,660.79
$1,765.19
$1,875.79
$2,268.65 		$295.81
Toc - Plan #14 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X HMO 9100/0% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$380.09
$431.40
$485.76
$678.84
$1,031.56 		$670.86
$722.17
$776.53
$969.61 		$961.63
$1,012.94
$1,067.30
$1,260.38 		$1,252.40
$1,303.71
$1,358.07
$1,551.15 		$290.77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$760.18
$862.80
$971.52
$1,357.68
$2,063.12 		$1,050.95
$1,153.57
$1,262.29
$1,648.45 		$1,341.72
$1,444.34
$1,553.06
$1,939.22 		$1,632.49
$1,735.11
$1,843.83
$2,229.99 		$290.77
Toc - Plan #15 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$416.14
$472.32
$531.83
$743.23
$1,129.40 		$734.49
$790.67
$850.18
$1,061.58 		$1,052.84
$1,109.02
$1,168.53
$1,379.93 		$1,371.19
$1,427.37
$1,486.88
$1,698.28 		$318.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$832.28
$944.64
$1,063.66
$1,486.46
$2,258.80 		$1,150.63
$1,262.99
$1,382.01
$1,804.81 		$1,468.98
$1,581.34
$1,700.36
$2,123.16 		$1,787.33
$1,899.69
$2,018.71
$2,441.51 		$318.35
Toc - Plan #16 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X HMO 5800/40% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$496.24
$563.23
$634.19
$886.28
$1,346.80 		$875.86
$942.85
$1,013.81
$1,265.90 		$1,255.48
$1,322.47
$1,393.43
$1,645.52 		$1,635.10
$1,702.09
$1,773.05
$2,025.14 		$379.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$992.48
$1,126.46
$1,268.38
$1,772.56
$2,693.60 		$1,372.10
$1,506.08
$1,648.00
$2,152.18 		$1,751.72
$1,885.70
$2,027.62
$2,531.80 		$2,131.34
$2,265.32
$2,407.24
$2,911.42 		$379.62
Toc - Plan #17 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X HMO 2000/25% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$720.34
$817.59
$920.59
$1,286.53
$1,955.00 		$1,271.40
$1,368.65
$1,471.65
$1,837.59 		$1,822.46
$1,919.71
$2,022.71
$2,388.65 		$2,373.52
$2,470.77
$2,573.77
$2,939.71 		$551.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,440.68
$1,635.18
$1,841.18
$2,573.06
$3,910.00 		$1,991.74
$2,186.24
$2,392.24
$3,124.12 		$2,542.80
$2,737.30
$2,943.30
$3,675.18 		$3,093.86
$3,288.36
$3,494.36
$4,226.24 		$551.06

ADVERTISEMENT

CareSource

Local: 1-833-230-2099 | Toll Free: 1-833-230-2099 | TTY: 1-800-750-0750
Toc - Plan #18 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$395.11
$448.44
$504.94
$705.66
$1,072.31 		$697.37
$750.70
$807.20
$1,007.92 		$999.63
$1,052.96
$1,109.46
$1,310.18 		$1,301.89
$1,355.22
$1,411.72
$1,612.44 		$302.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$790.22
$896.88
$1,009.88
$1,411.32
$2,144.62 		$1,092.48
$1,199.14
$1,312.14
$1,713.58 		$1,394.74
$1,501.40
$1,614.40
$2,015.84 		$1,697.00
$1,803.66
$1,916.66
$2,318.10 		$302.26
Toc - Plan #19 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$558.91
$634.36
$714.29
$998.21
$1,516.88 		$986.48
$1,061.93
$1,141.86
$1,425.78 		$1,414.05
$1,489.50
$1,569.43
$1,853.35 		$1,841.62
$1,917.07
$1,997.00
$2,280.92 		$427.57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,117.82
$1,268.72
$1,428.58
$1,996.42
$3,033.76 		$1,545.39
$1,696.29
$1,856.15
$2,423.99 		$1,972.96
$2,123.86
$2,283.72
$2,851.56 		$2,400.53
$2,551.43
$2,711.29
$3,279.13 		$427.57
Toc - Plan #20 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$403.54
$458.01
$515.72
$720.71
$1,095.19 		$712.24
$766.71
$824.42
$1,029.41 		$1,020.94
$1,075.41
$1,133.12
$1,338.11 		$1,329.64
$1,384.11
$1,441.82
$1,646.81 		$308.70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$807.08
$916.02
$1,031.44
$1,441.42
$2,190.38 		$1,115.78
$1,224.72
$1,340.14
$1,750.12 		$1,424.48
$1,533.42
$1,648.84
$2,058.82 		$1,733.18
$1,842.12
$1,957.54
$2,367.52 		$308.70
Toc - Plan #21 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$293.05
$332.61
$374.51
$523.38
$795.32 		$517.23
$556.79
$598.69
$747.56 		$741.41
$780.97
$822.87
$971.74 		$965.59
$1,005.15
$1,047.05
$1,195.92 		$224.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$586.10
$665.22
$749.02
$1,046.76
$1,590.64 		$810.28
$889.40
$973.20
$1,270.94 		$1,034.46
$1,113.58
$1,197.38
$1,495.12 		$1,258.64
$1,337.76
$1,421.56
$1,719.30 		$224.18
Toc - Plan #22 CareSource
Bronze

(HMO) CareSource Marketplace Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$286.65
$325.35
$366.34
$511.96
$777.97 		$505.94
$544.64
$585.63
$731.25 		$725.23
$763.93
$804.92
$950.54 		$944.52
$983.22
$1,024.21
$1,169.83 		$219.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$573.30
$650.70
$732.68
$1,023.92
$1,555.94 		$792.59
$869.99
$951.97
$1,243.21 		$1,011.88
$1,089.28
$1,171.26
$1,462.50 		$1,231.17
$1,308.57
$1,390.55
$1,681.79 		$219.29
Toc - Plan #23 CareSource
Silver

(HMO) CareSource Marketplace Essential Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$6,150 $12,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$451.76
$512.74
$577.34
$806.84
$1,226.06 		$797.35
$858.33
$922.93
$1,152.43 		$1,142.94
$1,203.92
$1,268.52
$1,498.02 		$1,488.53
$1,549.51
$1,614.11
$1,843.61 		$345.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$903.52
$1,025.48
$1,154.68
$1,613.68
$2,452.12 		$1,249.11
$1,371.07
$1,500.27
$1,959.27 		$1,594.70
$1,716.66
$1,845.86
$2,304.86 		$1,940.29
$2,062.25
$2,191.45
$2,650.45 		$345.59
Toc - Plan #24 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$401.46
$455.66
$513.07
$717.01
$1,089.56 		$708.58
$762.78
$820.19
$1,024.13 		$1,015.70
$1,069.90
$1,127.31
$1,331.25 		$1,322.82
$1,377.02
$1,434.43
$1,638.37 		$307.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$802.92
$911.32
$1,026.14
$1,434.02
$2,179.12 		$1,110.04
$1,218.44
$1,333.26
$1,741.14 		$1,417.16
$1,525.56
$1,640.38
$2,048.26 		$1,724.28
$1,832.68
$1,947.50
$2,355.38 		$307.12
Toc - Plan #25 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$566.61
$643.10
$724.12
$1,011.96
$1,537.77 		$1,000.06
$1,076.55
$1,157.57
$1,445.41 		$1,433.51
$1,510.00
$1,591.02
$1,878.86 		$1,866.96
$1,943.45
$2,024.47
$2,312.31 		$433.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,133.22
$1,286.20
$1,448.24
$2,023.92
$3,075.54 		$1,566.67
$1,719.65
$1,881.69
$2,457.37 		$2,000.12
$2,153.10
$2,315.14
$2,890.82 		$2,433.57
$2,586.55
$2,748.59
$3,324.27 		$433.45
Toc - Plan #26 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$409.88
$465.21
$523.83
$732.05
$1,112.42 		$723.44
$778.77
$837.39
$1,045.61 		$1,037.00
$1,092.33
$1,150.95
$1,359.17 		$1,350.56
$1,405.89
$1,464.51
$1,672.73 		$313.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$819.76
$930.42
$1,047.66
$1,464.10
$2,224.84 		$1,133.32
$1,243.98
$1,361.22
$1,777.66 		$1,446.88
$1,557.54
$1,674.78
$2,091.22 		$1,760.44
$1,871.10
$1,988.34
$2,404.78 		$313.56
Toc - Plan #27 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$298.74
$339.06
$381.78
$533.54
$810.76 		$527.27
$567.59
$610.31
$762.07 		$755.80
$796.12
$838.84
$990.60 		$984.33
$1,024.65
$1,067.37
$1,219.13 		$228.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$597.48
$678.12
$763.56
$1,067.08
$1,621.52 		$826.01
$906.65
$992.09
$1,295.61 		$1,054.54
$1,135.18
$1,220.62
$1,524.14 		$1,283.07
$1,363.71
$1,449.15
$1,752.67 		$228.53
Toc - Plan #28 CareSource
Bronze

(HMO) CareSource Marketplace Bronze Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$292.01
$331.43
$373.19
$521.53
$792.52 		$515.40
$554.82
$596.58
$744.92 		$738.79
$778.21
$819.97
$968.31 		$962.18
$1,001.60
$1,043.36
$1,191.70 		$223.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$584.02
$662.86
$746.38
$1,043.06
$1,585.04 		$807.41
$886.25
$969.77
$1,266.45 		$1,030.80
$1,109.64
$1,193.16
$1,489.84 		$1,254.19
$1,333.03
$1,416.55
$1,713.23 		$223.39
Toc - Plan #29 CareSource
Silver

(HMO) CareSource Marketplace Essential Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$6,150 $12,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$457.90
$519.71
$585.19
$817.80
$1,242.72 		$808.19
$870.00
$935.48
$1,168.09 		$1,158.48
$1,220.29
$1,285.77
$1,518.38 		$1,508.77
$1,570.58
$1,636.06
$1,868.67 		$350.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$915.80
$1,039.42
$1,170.38
$1,635.60
$2,485.44 		$1,266.09
$1,389.71
$1,520.67
$1,985.89 		$1,616.38
$1,740.00
$1,870.96
$2,336.18 		$1,966.67
$2,090.29
$2,221.25
$2,686.47 		$350.29

ADVERTISEMENT

MedMutual

Local: 1-888-308-0357 | Toll Free: 1-888-308-0357

Toc - Plan #30 MedMutual
Silver

(HMO) Market HMO 3500 - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$448.23
$508.74
$572.84
$800.54
$1,216.50 		$791.13
$851.64
$915.74
$1,143.44 		$1,134.03
$1,194.54
$1,258.64
$1,486.34 		$1,476.93
$1,537.44
$1,601.54
$1,829.24 		$342.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$896.46
$1,017.48
$1,145.68
$1,601.08
$2,433.00 		$1,239.36
$1,360.38
$1,488.58
$1,943.98 		$1,582.26
$1,703.28
$1,831.48
$2,286.88 		$1,925.16
$2,046.18
$2,174.38
$2,629.78 		$342.90
Toc - Plan #31 MedMutual
Silver

(HMO) Market HMO 4000 HSA - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$5,850 $11,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$448.57
$509.13
$573.27
$801.15
$1,217.42 		$791.73
$852.29
$916.43
$1,144.31 		$1,134.89
$1,195.45
$1,259.59
$1,487.47 		$1,478.05
$1,538.61
$1,602.75
$1,830.63 		$343.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$897.14
$1,018.26
$1,146.54
$1,602.30
$2,434.84 		$1,240.30
$1,361.42
$1,489.70
$1,945.46 		$1,583.46
$1,704.58
$1,832.86
$2,288.62 		$1,926.62
$2,047.74
$2,176.02
$2,631.78 		$343.16
Toc - Plan #32 MedMutual
Expanded Bronze

(HMO) Market HMO 7000 HSA - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$341.19
$387.25
$436.04
$609.36
$925.98 		$602.20
$648.26
$697.05
$870.37 		$863.21
$909.27
$958.06
$1,131.38 		$1,124.22
$1,170.28
$1,219.07
$1,392.39 		$261.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$682.38
$774.50
$872.08
$1,218.72
$1,851.96 		$943.39
$1,035.51
$1,133.09
$1,479.73 		$1,204.40
$1,296.52
$1,394.10
$1,740.74 		$1,465.41
$1,557.53
$1,655.11
$2,001.75 		$261.01
Toc - Plan #33 MedMutual
Bronze

(HMO) Market HMO 9100 - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$322.84
$366.42
$412.58
$576.58
$876.17 		$569.81
$613.39
$659.55
$823.55 		$816.78
$860.36
$906.52
$1,070.52 		$1,063.75
$1,107.33
$1,153.49
$1,317.49 		$246.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$645.68
$732.84
$825.16
$1,153.16
$1,752.34 		$892.65
$979.81
$1,072.13
$1,400.13 		$1,139.62
$1,226.78
$1,319.10
$1,647.10 		$1,386.59
$1,473.75
$1,566.07
$1,894.07 		$246.97
Toc - Plan #34 MedMutual
Catastrophic

(HMO) Market HMO Young Adult Essentials - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$212.39
$241.06
$271.44
$379.33
$576.43 		$374.87
$403.54
$433.92
$541.81 		$537.35
$566.02
$596.40
$704.29 		$699.83
$728.50
$758.88
$866.77 		$162.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$424.78
$482.12
$542.88
$758.66
$1,152.86 		$587.26
$644.60
$705.36
$921.14 		$749.74
$807.08
$867.84
$1,083.62 		$912.22
$969.56
$1,030.32
$1,246.10 		$162.48
Toc - Plan #35 MedMutual
Silver

(HMO) Market HMO 6500 - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$446.87
$507.20
$571.10
$798.11
$1,212.81 		$788.73
$849.06
$912.96
$1,139.97 		$1,130.59
$1,190.92
$1,254.82
$1,481.83 		$1,472.45
$1,532.78
$1,596.68
$1,823.69 		$341.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$893.74
$1,014.40
$1,142.20
$1,596.22
$2,425.62 		$1,235.60
$1,356.26
$1,484.06
$1,938.08 		$1,577.46
$1,698.12
$1,825.92
$2,279.94 		$1,919.32
$2,039.98
$2,167.78
$2,621.80 		$341.86
Toc - Plan #36 MedMutual
Expanded Bronze

(HMO) Market HMO Select Bronze - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$385.36
$437.39
$492.49
$688.26
$1,045.88 		$680.16
$732.19
$787.29
$983.06 		$974.96
$1,026.99
$1,082.09
$1,277.86 		$1,269.76
$1,321.79
$1,376.89
$1,572.66 		$294.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$770.72
$874.78
$984.98
$1,376.52
$2,091.76 		$1,065.52
$1,169.58
$1,279.78
$1,671.32 		$1,360.32
$1,464.38
$1,574.58
$1,966.12 		$1,655.12
$1,759.18
$1,869.38
$2,260.92 		$294.80
Toc - Plan #37 MedMutual
Silver

(HMO) Market HMO Select Silver - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$481.87
$546.93
$615.83
$860.63
$1,307.81 		$850.50
$915.56
$984.46
$1,229.26 		$1,219.13
$1,284.19
$1,353.09
$1,597.89 		$1,587.76
$1,652.82
$1,721.72
$1,966.52 		$368.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$963.74
$1,093.86
$1,231.66
$1,721.26
$2,615.62 		$1,332.37
$1,462.49
$1,600.29
$2,089.89 		$1,701.00
$1,831.12
$1,968.92
$2,458.52 		$2,069.63
$2,199.75
$2,337.55
$2,827.15 		$368.63
Toc - Plan #38 MedMutual
Expanded Bronze

(HMO) Market HMO 8000 - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$327.25
$371.43
$418.23
$584.47
$888.16 		$577.60
$621.78
$668.58
$834.82 		$827.95
$872.13
$918.93
$1,085.17 		$1,078.30
$1,122.48
$1,169.28
$1,335.52 		$250.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$654.50
$742.86
$836.46
$1,168.94
$1,776.32 		$904.85
$993.21
$1,086.81
$1,419.29 		$1,155.20
$1,243.56
$1,337.16
$1,669.64 		$1,405.55
$1,493.91
$1,587.51
$1,919.99 		$250.35
Toc - Plan #39 MedMutual
Gold

(HMO) Market HMO 2500 - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$5,750 $11,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$594.02
$674.21
$759.15
$1,060.91
$1,612.16 		$1,048.44
$1,128.63
$1,213.57
$1,515.33 		$1,502.86
$1,583.05
$1,667.99
$1,969.75 		$1,957.28
$2,037.47
$2,122.41
$2,424.17 		$454.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,188.04
$1,348.42
$1,518.30
$2,121.82
$3,224.32 		$1,642.46
$1,802.84
$1,972.72
$2,576.24 		$2,096.88
$2,257.26
$2,427.14
$3,030.66 		$2,551.30
$2,711.68
$2,881.56
$3,485.08 		$454.42
Toc - Plan #40 MedMutual
Gold

(HMO) Market HMO Standard Gold - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$571.25
$648.37
$730.06
$1,020.25
$1,550.37 		$1,008.25
$1,085.37
$1,167.06
$1,457.25 		$1,445.25
$1,522.37
$1,604.06
$1,894.25 		$1,882.25
$1,959.37
$2,041.06
$2,331.25 		$437.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,142.50
$1,296.74
$1,460.12
$2,040.50
$3,100.74 		$1,579.50
$1,733.74
$1,897.12
$2,477.50 		$2,016.50
$2,170.74
$2,334.12
$2,914.50 		$2,453.50
$2,607.74
$2,771.12
$3,351.50 		$437.00
Toc - Plan #41 MedMutual
Silver

(HMO) Market HMO Standard Silver - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$444.83
$504.89
$568.50
$794.47
$1,207.28 		$785.13
$845.19
$908.80
$1,134.77 		$1,125.43
$1,185.49
$1,249.10
$1,475.07 		$1,465.73
$1,525.79
$1,589.40
$1,815.37 		$340.30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$889.66
$1,009.78
$1,137.00
$1,588.94
$2,414.56 		$1,229.96
$1,350.08
$1,477.30
$1,929.24 		$1,570.26
$1,690.38
$1,817.60
$2,269.54 		$1,910.56
$2,030.68
$2,157.90
$2,609.84 		$340.30
Toc - Plan #42 MedMutual
Expanded Bronze

(HMO) Market HMO Standard Expanded Bronze - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$349.34
$396.50
$446.46
$623.92
$948.11 		$616.59
$663.75
$713.71
$891.17 		$883.84
$931.00
$980.96
$1,158.42 		$1,151.09
$1,198.25
$1,248.21
$1,425.67 		$267.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$698.68
$793.00
$892.92
$1,247.84
$1,896.22 		$965.93
$1,060.25
$1,160.17
$1,515.09 		$1,233.18
$1,327.50
$1,427.42
$1,782.34 		$1,500.43
$1,594.75
$1,694.67
$2,049.59 		$267.25
Toc - Plan #43 MedMutual
Bronze

(HMO) Market HMO Standard Bronze - OhioHealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$326.57
$370.66
$417.36
$583.26
$886.32 		$576.40
$620.49
$667.19
$833.09 		$826.23
$870.32
$917.02
$1,082.92 		$1,076.06
$1,120.15
$1,166.85
$1,332.75 		$249.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$653.14
$741.32
$834.72
$1,166.52
$1,772.64 		$902.97
$991.15
$1,084.55
$1,416.35 		$1,152.80
$1,240.98
$1,334.38
$1,666.18 		$1,402.63
$1,490.81
$1,584.21
$1,916.01 		$249.83

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Noble County here.

Noble County is in “Rating Area 16” of Ohio.

Currently, there are 43 plans offered in Rating Area 16.

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2023 Obamacare Plans for Noble County, OH

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